Examining the Role of Cerebral Embolic Protection Devices in Preventing Postoperative Stroke in Patients with a History of Stroke or Transient Ischemic: Insights from the National Inpatient Sample

Rupak Desai; Avilash Mondal; Nishanth Katukuri; Adhvithi Pingili; Vamsikalyan Borra; Parth R Nayak; Akhil Jain; Harshil Patel; Omar Qaqish; Ankit Vyas; Ashok Kondur

doi:10.1097/CRD.0000000000000674

Examining the Role of Cerebral Embolic Protection Devices in Preventing Postoperative Stroke in Patients with a History of Stroke or Transient Ischemic: Insights from the National Inpatient Sample

Cardiol Rev. 2024 Mar 4. doi: 10.1097/CRD.0000000000000674. Online ahead of print.

Authors

Rupak Desai¹, Avilash Mondal², Nishanth Katukuri³, Adhvithi Pingili⁴, Vamsikalyan Borra⁵, Parth R Nayak⁶, Akhil Jain⁷, Harshil Patel⁸, Omar Qaqish⁹, Ankit Vyas¹⁰, Ashok Kondur⁹

Affiliations

¹ Independent Researcher, Atlanta, GA.
² Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA.
³ Department of Internal Medicine, Mayo Clinic, Rochester, MN.
⁴ Department of Internal Medicine, MedStar Health Baltimore, Baltimore, MD.
⁵ Department of Internal Medicine, The University of Texas Rio Grande Valley, Weslaco, TX.
⁶ Department of Physiology, Ananya College of Medicine and Research Kalol, India.
⁷ Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA.
⁸ Division of Cardiology, Ascension Providence Hospital, MI.
⁹ Division of Cardiology, Garden City Hospital, MI.
¹⁰ Department of Vascular Medicine, Ochsner Clinic Foundation, New Orleans, LA.

PMID: 38436403
DOI: 10.1097/CRD.0000000000000674

Abstract

Cerebral embolic protection devices (CEPD) during transcatheter aortic valve replacement (TAVR) have been shown to lower the risk of stroke during the procedure. However, their long-term and clinical effects on neuro-cognition are unknown. Therefore, we hypothesized the benefit of CEPD in TAVR patients with a prior history of stroke or transient ischemic attack (TIA). National Inpatient Sample (2019) and International Classification of Diseases, 10th Revision codes were used to identify patients undergoing TAVR with prior stroke or TIA. Propensity-matched analysis was performed to adjust for baseline characteristics and comorbidities. Primary outcome measures were postoperative stroke and all-cause mortality. Length of stay and hospital cost were secondary outcomes. Of 8450 unmatched TAVR patients with prior stroke or TIA in 2019, 1095 (13%) utilized CEPD. After propensity matching previous myocardial infarction (MI), coronary artery bypass grafting, and drug abuse were higher in the TAVR-only cohort. Postoperative stroke rate (1.4% vs 2.2%; P = 0.081) and odds [adjusted odds ratio (aOR), 0.48; 95% confidence interval (CI), 0.11-2.17; P = 0.341] were lower in the CEPD group. There was no difference in all-cause in-hospital mortality between the 2 groups (0.9% vs 1.0%). Length of stay (3 vs 2 days, P <0.001) and hospital expenditure ($172,711 vs $162,284; P = 0.002) were higher for the TAVR-only cohort. CEPD in TAVR patients with prior stroke or TIA did not show statistically significant postoperative stroke benefits. However, further larger-scale prospective studies are needed to evaluate the long-term neurocognitive benefits of CEPD in these patients. As the use of TAVR continues to expand, optimizing peri-procedural strategies such as the use of CEPD remains a critical area of research to improve patient outcomes.